What is a disability? Really?

I volunteer at the Arizona Animal Welfare League on Friday afternoons. We are a no-kill shelter that rescues animals from other local shelters who have been placed on the euthanasia list. This past Friday, we took in a remarkable young cat who humbled us all and who made me think about what it means to be disabled.

You see, Helen is blind. She's just 8 months old, and her eyes are clouded with cataracts. In addition to coming to us with this issue, her back was shaved and sewn up where the vets had treated several puncture wounds. As well fed as she appeared to be, it seems as though Helen accidentally slipped out of her home and found her way into the jaws of a predator.

So by the time this little kitty, who could not see, had found her way to us,she'd (1) lost her way, (2) been confused and disoriented, (3) almost been eaten, (4) been captured, (5) ridden in a van to the Humane Society where she was placed in a cage in the same noisy aisle with anxious barking dogs, (6) been poked and prodded and operated on, (7) been put in another van to come to us, (8) been poked and prodded yet again for our intake, (9) been put in yet another strange cage. That's a lot to take in when you can't see, everything is strange, and no one can explain to you in a way that you understand what is going on, and that things are going to get much, much better very, very soon.

I helped with the intake. And as much sympathy as I had for Helen, recognizing that she could very well be at her kitty breaking point, I was a little hesitant to pick her up to put her on the scale. When I did, she was a little nervous, but let me guide her through the process.

I picked her up to snuggle her after that, making sure all four of her feet were against my body to help her feel secure. She immediately went limp and let me comfort her. When it was time to put her in her cage, she didn't fight. She positioned herself right near the front and hung her paws out the door, very happy, it seemed, to have a safe place to collapse.

I couldn't stop thinking about her Friday night, so I went in the next day to spend time with her. I took her out of the cage, and sat on the floor, with the intent of petting her. Helen would have none of it. She immediately stood up and started walking around the room, investigating her surroundings. Her steps were deliberate, but she didn't miss a detail. Within a half hour, she knew the layout of the room. Within the next half hour, she had befriended the curious kitten who had been watching this process, sensed something was different about his new friend, and who extended a paw in a careful, considerate gesture.

While I watched Helen go about life as if it was just another day, I realized...the only ones who saw her as disabled, were the people taking care of her! Helen had never been able to see, so she didn't know there was such a concept. She didn't speak our language, so no one could tell her she had anything to feel sorry for herself about. She just had the life she had, and she was going about it the way she always had.

It reminded me of so many of the people I work with in my profession. In medicine, we define people by the diagnoses for which we treat them. But what seems to happen is that those labels set up the expectations we have for our clients. And the clients live up to our expectations, high or low. We often don't let the client decide just what it's going to mean to have diabetes...or bipolar disorder...or infertility. We label them, tell them what the label is, tell them all the things they shouldn't do because they now fit into a specific category. And in doing so, we set ourselves up to be the worst possible influence that person ever had as far as setting out to achieve their potential.

Of course, having a medical diagnosis can change who you are! But that isn't necessarily a bad thing! Just ask Abraham Lincoln and Winston Churchill, who were both supposedly bipolar. Who knows...maybe it was the way bipolar disorder hardwired their brains that set them up to be the great achievers they ended up to be?

Sometimes, the very thing about us that we choose to use as our reason to limit our expectations and efforts, is the very thing that makes us unique and special and just a cut above average.

I'd say just ask Helen the cat...but she's too busy being Special Helen to worry about what you think of her.

See for yourself! http://www.aawl.org/pet_detail.asp?id=975

I'm offering a nutrition class in Tempe, Arizona and Marina del Rey, California

Hello visitor!

If you are female, and your psychiatric medication has caused weight gain, insulin resistance/diabetes, high cholesterol, and/or infertility, please join me in a class designed especially for you!

I will be at the Tempe Whole Foods on Monday, April 7, and at Panera Bread in Marina del Rey on Wednesday, April 16, from 6:30-8:30 pm in both locations. There is a fee of $15 to participate, and I do ask that you reserve your spot and pay in advance.

For more information, please visit the following link: http://afterthediet.com/inCYST.htm

I have also been asked if I will do personal consultations on my trips to California. I can do that if arranged and paid in advance. I can consult with men as well, the reason the class is for women only is because so much of the agenda is about the infertility aspect of the problem...which makes most men squirm!

Hope to see you in class!

Asthma medication and suicide

You've probably seen by now, that the asthma medication Singulair may be linked to suicidal tendencies.

I have noticed, over the past few years, that medications used to treat imbalances potentially related to inflammation (which some asthma is), seem to be pulled off the market because of their side effects. I'm not sure what the reason is for this, it just seems to happen fairly frequently.

I'm wondering if part of the problem is how Western medicine defines and treats inflammation...as a symptom that can be treated with a medication.

I started this blog because I believe that a lot of the inflammatory process causing so much illness today, is more about lifestyle--what we eat, how active we are, how much and how well we sleep, and how we manage stress. There isn't a pill we can take that can outweigh the benefits of those simple choices.

It's a hard reality to accept, that the only person who can help us with most of our problems, is ourselves. It means saying no to things that may sound like fun, it means saying yes to things that may not be as fun as other options, but in the long run, making those choices can reduce the need for many medications and help us to feel better, much longer into life.

Antipsychotics and cardiac-related sudden death: could selenium be important?

Scientists have started to notice that there is a relationship between the use of antipsychotic (neuroleptic) medications and the development of heart lesions. They have also noticed that these lesions, in other individuals, can be related to selenium levels. So, one research group in France decided to see what was happening to selenium levels in the presence of antipsychotic medications. (This study was done on rabbits.)

Half of the rabbits were given risperidone (Risperdal) and the other half levomepromazine (not available in the US), via intramuscular injection. Another group of rabbits was given a saline injection instead of medication.

Blood samples at the end of 3 months had 20% less selenium than blood samples taken at the beginning of the study. Heart tissue had 50% less selenium at the end of the study. In addition, these rabbits' hearts had disorganization of cardiac fibers, myolysis (dissolved muscle tissue), interstitial and endocardial fibrosis (development of fiber-like tissue), and necrosis (dead tissue) were noted in medication-treated animals, but not in controls.

The next step is logically going to be, whether or not supplemental selenium can help to prevent these negative side effects, and if so, how much is needed.

In the meantime, sounds to me like making sure if you are on an antipsychotic, that you take a supplement including selenium, and that you schedule regular visits with your cardiologist.

It's another reason I feel that eating well when on psychiatric medications is so important. If you're optimizing your diet, you may be able to minimize the amount of medication you need, ultimately reducing the potential for side effects that are at least as troublesome as the problem you're trying to help.

Vaillant F, Turrel F, Bost M, Bricca G, Descotes J, Bui-Xuan B, Tabib A, Manati W, Timour Q. Role of selenium in heart lesions produced by neuroleptics in the rabbit. J Appl Toxicol. 2008 Mar;28(2):212-6.

Antipsychotics, weight gain, and beautiful minds

My very first experience in mental health was with a young man with schizophrenia who was also diabetic. It was very challenging to help him with his diet, because he was pretty obsessed with telling me how he'd been recruited away from his professional football career to invent the atomic bomb, and that he'd recently invented the Toyota Corolla. I remember thinking, even as a young intern, that it was sad that someone with so much creative energy was sitting in a locked psychiatric unit instead of focusing his mind in a productive direction.

It turns out, schizophrenia and diabetes are a very common combination. No one really knows why, but my guess is that with time, we'll learn that there is some kind of genetic link between the two problems. What makes this relationship especially important to understand, is that there are medications for schizophrenia that can exacerbate the diabetes, as well as other metabolic syndrome-related problems such as increased triglycerides.

A recent study showed that while rates of metabolic syndrome increased over time in patients prescribed antipsychotics, regardless of the specific type of medication, that the risk of developing metabolic syndrome was three times greater in those individuals using second generation antipsychotics. These people also experienced a greater degree of weight gain. The two medications that appeared to be the most problematic were olanzapine (Zyprexa) and clozapine (Clozaril).

The good news is, that there is also research supporting the fact that behavioral and nutrition "training" with individuals who are on these medications can help to lessen the degree of the negative side effects. I have worked with individuals who have not been able to manage their schizophrenia without using one of these two medications, so I understand their value and necessity for the well-being, productivity, and SAFETY of many people who use them. I just wish that every physician who prescribed them also automatically referred their patient to a nutrition professional who could maximize the benefit of the medication while minimizing the risks these medications pose. And I wish that insurance companies would recognize the importance of utilizing this kind of professional help in mental health, so that reimbursement was available. That would encourage many of these people to actually seek help before problems even started.

Sometimes we assume that when a person has a diagnosis such as schizophrenia, or bipolar disorder, that they aren't a candidate for certain types of services. I've not experienced that at all. In fact, some of my most motivated clients have been individuals with these diagnoses. I love my time with them because they are often highly intelligent and creative. They just need people in their lives who take them seriously, who assume that they're intelligent and treat them as such, and who are willing to show them the ropes as far as being healthy.

I think, if I went through my life being treated as if I was not intelligent, that I'd start to believe it myself. Maybe someday, we won't be so afraid of diagnoses such as schizophrenia, and we'll be as comfortable interacting with people who have mental diagnoses as we are with people who have diabetes or high cholesterol.

Imagine how many potential Vincent Van Goghs and John Forbes Nash Jrs. (A Beautiful Mind) are out there just waiting for us to help them access their potential?

De Hert M, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Sinko S, Wampers M, Scheen A, Peuskens J, van Winkel R. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review. Schizophr Res. 2008 Feb 23 [Epub ahead of print]

Kalarchian MA, Marcus MD, Levine MD, Haas GL, Greeno CG, Weissfeld LA, Qin L. Behavioral treatment of obesity in patients taking antipsychotic medications. J Clin Psychiatry 2005 Aug;66(8):1058-63.

Wu MK, Wang CK, Bai YM, Huang CY, Lee SD. Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Psychiatr Serv 2007 Apr;58(4):544-50.

Scocco P, Longo R, Caon F. Weight change in treatment with olanzapine and a psychoeducational approach. Eat Behav 2006 May;7(2):115-24.

Kwon JS, Choi JS, Bahk WM, Yoon Kim C, Hyung Kim C, Chul ShinY, Park BJ, Geun Oh C. Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial. J Clin Psychiatry 2006 Apr;67(4):547-53.

Alvarez Jimenez M, Gonzalez Glanch C, Vazquez Barquero JL, Perez Iglesias R, Matinez Garcia O, Perez Pardal T, Ramirez Bonilla ML, Crespo Facorro B. Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial. J Clin Psychiatry 2006 Aug;67(8):1253-60.

Mauri M, Simoncini M, Castrogiovanni S, Iovieno N, Cecconi D, Dell'agnello G, Quadrigli M, Rossi A, Donda P, Fagiolini A, Cassano GB. A Psychoeducational Program for Weight Loss in Patients who have Experienced Weight Gain during Antipsychotic Treatment with Olanzapine. Pharmacopsychiatry. 2008 Jan;41(1):17-23.

Olanzapine and stuttering

This is science the way I love to see it.

Olanzapine (Zyprexa) is a popular antipsychotic for which I've found about 30 reported off-label uses in the literature. Rationales for off-label uses of medications are not always bad, but since this medication also has a large body of research documenting its potential to provoke diabetes and heart disease, it has always seemed to me that off-label uses for this medication should be very judicious and sparing.

The reference below challenges one of those off-label uses--stuttering. After reviewing literature, the authors concluded that there was insufficient evidence to support the use of olanzapine as a treatment modality for this problem.

Medications are chemicals. Yes, they can be miraculous in some cases. But they are not always the answer.

As I've encouraged before, I'll remind you again. If you're prescribed a medication, understand before agreeing to use it if the intended use is FDA-approved or off-label. And even if it's FDA-approved, know beforehand what the risks and potential side effects of this medication can be. Be informed.

Bothe AK, Franic DM, Ingham RJ, Davidow JH. Pharmacological approaches to stuttering treatment: reply to meline and harn (2008). Am J Speech Lang Pathol. 2008 Feb;17(1):98-101.

A new, more weight friendly form of Zyprexa?

My CD-rom on psychotropic medications got its original start a few years ago when clinicians were beginning to report that olanzapine (Zyprexa) seemed to be triggering significant weight gain in persons who were using it. To this day, the issue of weight gain and Zyprexa use continues to be a frequently appearing topic in Pub Med.

I just ran across an abstract describing a new formulation of Zyprexa that reportedly does not cause this weight gain. The original formulation was a standard oral tablet; the new formulation is an "orally disintegrating tablet".

This is new information to me, and I have not had the opportunity to see this benefit in action.

If you happen to be reading this post and you HAVE had experience, either similar or to the contrary, I'd love it if you shared it with the rest of us!

Have a great weekend,

Monika

Chawla B, Luxton-Andrew H. Long-term weight loss observed with olanzapine orally disintegrating tablets in overweight patients with chronic schizophrenia. A 1 year open-label, prospective trial. Hum Psychopharmacol. 2008 Jan 24

Lamictal and your baby? Maybe not the greatest combination

It can be a quandary if you have epilepsy and you want a child...manage your seizures or have a healthy baby? It's important to work with a physician who knows epilepsy medications inside and out before you get to a point where this is even an issue.

For example, lamotrigine (Lamictal), a medication I know is a favorite in the population I work with because it is less likely to provoke polycystic ovary syndrome than other medications, was reported in the study referenced below, to cause hippocampal and cortical malformations. (The hippocampus is the brain's factual memory center and the cortex is where many "human" executive functions are organized and carried out.) These malformations did not occur at large, research-provoked doses, but rather at blood concentrations in the mother that would be considered clinically effective.

In the same study, topiramate (Topamax), phenobarbitol, and levetiracetam (Keppra) did not have the same effect.

No option will be 100% safe or perfect, that's just how it is with science/medicine. The best defenses you can have if you're a woman with epilepsy in your child-bearing years, is to have or find an epilepsy physician with whom you can develop a collaborative relationship...and to be informed.

Manent JB, Jorquera I, Franco V, Ben-Ari Y, Perucca E, Represa A. Antiepileptic drugs and brain maturation: Fetal exposure to lamotrigine generates cortical malformations in rats. Epilepsy Res. 2008 Feb;78(2-3):131-9. Epub 2007 Dec 31.

What's in your water? And your soap, and your mascara, and your kitchen cleaner...

Since you're reading this post, you're online, and that likely means you've heard the "big" news about what's been found in our water. It's not really new news, but it's important news to pay attention to.

There's a lot of stuff in our water that shouldn't be. And it's been affecting the health of other species for a very long time. There are a whole lot of chemicals in our world that mimic hormones and cause a plethora of health problems. They get into the water too. These compounds are found in most cosmetics (which is why I am beginning to collaborate with Arbonne), many cleaning solvents, inks, fertilizers, paints, basically any chemical that was not known to man before 1900.

It's been a secondary mission of mine to create awareness of this issue, through the connection that these compounds affect hormone balance, which in turn affect mood, fertility, risk of heart disease and diabetes.....etc....etc....etc.

It didn't feel so great to see this on the news yesterday, but it did feel wonderful that a message I've been trying to get out there with my limited resources as a small business person was finally getting major attention. And in an election year, too! So maybe someone will finally grab onto it in a meaningful way. It's not a topic as glamorous as Iraq, or the economy, or what seems to be the political topic du jour...and grotesque birth defects and infertility are not the kind of things that give a candidate pretty, election-winning sound bites. But the issue affects each and every one of us, every day, in some pretty significant ways. I'm very distressed at the number of medications we have placed ourselves on, the rise in infertility, and the medical problems I now see in young people that used to be considered diseases of old age. It's no wonder the residual from that is showing up outside of our bodies.

I really hate the fact that this issue likely means job security for me. I'm trying to put myself out of business so I can improve my golf game!!!

This is not my area of expertise, it's merely a point of interest and something I am committed to providing awareness of. The website I've used for years, which is well researched and referenced, is http://e.hormone.tulane.edu. (Note there is no "www" in the URL.) They even have an annual conference on the topic, which I aspire to get to one of these days.

Maybe I'll see you there.

Folic acid, depression, and Prozac

Folic acid is clearly essential for brain and nervous system health.

When animals are depressed, they have a delayed response to stressful situations. Researchers in this study reported that rats given folic acid who were then forced to swim (a standard test for depression in lab rats, believe it or not!) started swimming sooner than rats who did not receive the supplement.

Folic acid also seemed to promote a synergistic effect with fluoxetine (Prozac), meaning in the presence of folic acid, Prozac was more effective. What this finding has the potential to translate into...is that if you DO need an antidepressant, eating well (or at least taking a multivitamin at the same time)may reduce the dose of the medication you actually need, which in turn reduces the potential for side effects. And side effects are a major reason why people do not maintain compliance with their psychotropic medications.

This seems like it's too simple to be true. But the reality is, when you're depressed, you may not feel like making the effort to eat well. Or, you grab something quick and easy (and likely low in essential vitamins/minerals and high in the wrong kind of fats), which only worsens the depression. If you have time to do only one thing a day that is just for YOU...make it eating well.

Whether it's a Flintstones or a One A Day, consider a multi as an essential part of your mental health bag of tricks!

Brocardo PS, Budni J, Kaster MP, Santos AR, Rodrigues AL. Folic acid administration produces an antidepressant-like effect in mice: Evidence for the involvement of the serotonergic and noradrenergic systems. Neuropharmacology. 2008 Feb;54(2):464-73. Epub 2007 Nov 5.

Your antidepressants and your baby's future drug habit

Whether it's food or drugs, the compounds in your body while your baby is developing can have a significant impact on your child. In this study, it is reported that (in rats) the offspring of mothers who were exposed to fluoxetine (Prozac) had fewer neurons in their nucleus accumbens, as well as less serotonin activity in their raphe nucleus. The nucleus accumbens is a brain region thought to be important in, among other things, reward, addiction, and pleasure. The raphe nucleus, a part of the brain stem, is responsible for releasing serotonin to other parts of the brain. With fewer neurons to tell the brain it's pleased, and less serotonin to help regulate mood, scientists wondered about the practical implications of these findings.

So....they put the offspring in a situation where they had free access to cocaine. Using a maze, they conditioned rats to associate a specific location of that maze with cocaine. Actually, the rats exposed to their mother's Prozac were a lot less active in the maze than rats who didn't have this exposure. However, those rats who did use the maze showed a preference for the location that had been associated with cocaine. When the cocaine was gradually removed from the protocol, Prozac-exposed rats took 350% longer to stop looking for the cocaine.

I don't need to add a comment, this study speaks for itself.

Forcelli PA, Heinrichs SC. Teratogenic effects of maternal antidepressant exposure on neural substrates of drug-seeking behavior in offspring. Addict Biol. 2008 Mar;13(1):52-62. Epub 2007 Sep 11.

Are you epileptic? Another reason to use folic acid during pregnancy

Most women these days are advised to use a folic acid supplement, even if they are not intending to become pregnant but there is a possibility that they might. In this study, researchers were interested to see if the incidence of birth defects in babies born to women using antiepileptics would be reduced if these women also took folic acid.

The medication history of the mothers of children born with birth defects was compared to the medication history of mothers whose children were not born with birth defects. The particular medication category of interest to these researchers was antiepileptics: carbemazepine (Tegretol), phenobarbital, phenytoin (Dilantin), and primidone (Mysoline).

The researchers found that if the mothers were using any of these medications, and they also used folic acid, that the risk of birth defects was decreased. It is important to note, however, that this risk did not completely go away.

It seems as though some of the best insurance for mothers and potential mothers is a simple folic acid supplement. Also, if you're thinking of becoming pregnant, or sexually active, it's important to let the caregiver managing your epilepsy know this, so that a treatment plan most beneficial to both mother and baby can be implemented.

I have to interject here, one of the most effective natural therapies for epilepsy, is fish oil. I get so frustrated that we encourage pregnant women not to eat fish, but then we seem to be ok giving them medications that might be worse! The recommendations for fish during pregnancy DO NOT say don't eat fish at all. They advise against four types of fish: shark, tilefish, King mackerel, and swordfish. If you're STILL hesitant about eating fish...you can either take a supplement that has been molecularly distilled, thereby removing the mercury, or you can use an algal-based supplement that is mercury free.

It's a very simple solution with the potential to put many researchers and drug company employees out of work, but this is not about who gets to work and who gets to make money. The last I heard, working in health care was about keeping people safe and healthy!

Kjaer D, Horvath-Puhó E, Christensen J, Vestergaard M, Czeizel AE, Sørensen HT, Olsen J. Antiepileptic drug use, folic acid supplementation, and congenital abnormalities: a population-based case-control study. BJOG. 2008 Jan;115(1):98-103. Epub 2007 Nov 12.

Mania and free fatty acids

Plasma free fatty acids (primarily omega-3's) have gained much attention for their therapeutic potential in many psychiatric diagnoses--including depression, anxiety, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, schizophrenia, post-traumatic stress disorder, and bipolar disorder. Now researchers are discovering that the level of these fatty acids in the blood may actually influence the symptom severity of these illnesses.

In this particular study, done in patients with bipolar disorder, medication-free patients who were seeking help for a manic episode had their blood tested for free fatty acid levels. These levels were compared to those in individuals who did not have bipolar disorder. In the manic individuals, the lower the levels of arachidonic acid (AA) or eicosapentaenoic acid (EPA), the worse the manic symptoms were. The greater the AA/EPA ratio, the worse the manic symptoms were.

In plain English? While the diets of these individuals were not analyzed, it is well-established that a diet high in fish and omega-3's promotes good EPA levels. A diet high in meat and pro-inflammatory oils (those "S" and "C" oils I like to refer to), the higher the AA levels.

So...eat a lot of meat and processed foods with the wrong kinds of fat, and your bipolar disorder stability might pay the price. Focus on fish, flax, and nuts...and you might not need as many emergency room visits.

It's kind of a catch-22. In working with bipolar disorder, it seems that the very foods that cause trouble are the very foods these individuals seem to crave. It can take a concerted effort to stay on track with nutrition. However...what I do notice is that if these individuals DO stick with the plan and pull their nervous systems back into balance, the cravings eventually lessen and appetites for healthier food begin to surface.

I've been in the presence of a client in the middle of her mania. At least from my shoes, on the outside looking in, knowing what danger her state put her in, I'd highly recommend making the effort and minimizing the manic episodes.


Sublette ME, Bosetti F, DeMar JC, Ma K, Bell JM, Fagin-Jones S, Russ MJ, Rapoport SI. Plasma free polyunsaturated fatty acid levels are associated with symptom severity in acute mania.Bipolar Disord. 2007 Nov;9(7):759-65.